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A practical approach to uveitis screening in children with juvenile idiopathic arthritis
Ivan Foeldvari1, Marcela Bohn2,3, Harry Petrushkin2,4
1Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, Germany foeldvari@t-online.de.
Insights
Simplified screening protocols for juvenile idiopathic arthritis (JIA) uveitis can improve early detection and prevent blindness. New recommendations focus on age at JIA onset, making screening easier for local eye care professionals.
Area of Science:
- Ophthalmology
- Pediatric Rheumatology
- Public Health
Background:
- Juvenile idiopathic arthritis (JIA)-associated uveitis is a leading cause of childhood blindness.
- Current screening guidelines are complex, hindering adherence by local eye care professionals (ECPs).
- A need exists for simplified, confident screening protocols for JIA-associated uveitis.
Framework:
- A consensus meeting of pediatric rheumatologists and ophthalmologists was held in January 2023.
- Evidence for JIA screening was reviewed.
- A nominal group technique facilitated consensus on new screening recommendations.
Implementation:
- Three standardized screening recommendations were developed and approved.
- The new approach simplifies JIA screening by focusing on age at onset.
- It removes the need for detailed JIA categorization, antibody status, or treatment information.
Implications:
- Easier implementation by local ECPs with limited patient information.
- Potential to significantly improve the standard of care for JIA-associated uveitis.
- Provides a practical, safe approach for early uveitis detection in children.
Background:
Juvenile idiopathic arthritis (JIA)-associated uveitis typically presents as a silent chronic anterior uveitis and can lead to blindness. Adherence to current screening guidelines is hampered by complex protocols which rely on the knowledge of specific JIA characteristics. The Multinational Interdisciplinary Working Group for Uveitis in Childhood identified the need to simplify screening to enable local eye care professionals (ECPs), who carry the main burden, to screen children with JIA appropriately and with confidence.
Methods:
A consensus meeting took place in January 2023 in Barcelona, Spain, with an expert panel of 10 paediatric rheumatologists and 5 ophthalmologists with expertise in paediatric uveitis. A summary of the current evidence for JIA screening was presented. A nominal group technique was used to reach consensus.
Results:
The need for a practical but safe approach that allows early uveitis detection was identified by the panel. Three screening recommendations were proposed and approved by the voting members. They represent a standardised approach to JIA screening taking into account the patient's age at the onset of JIA to determine the screening interval until adulthood.
Conclusion:
By removing the need for the knowledge of JIA categories, antinuclear antibody positivity or treatment status, the recommendations can be more easily implemented by local ECP, where limited information is available. It would improve the standard of care on the local level significantly. The proposed protocol is less tailored to the individual than the 'gold standard' ones it references and does not aim to substitute those where they are being used with confidence.
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